Insurance News Update–May 2015

health-insurance-shoppingMedicare does not cover acupuncture. But if you are covered by Medicare as well as a secondary insurance which does cover acupuncture, then we can bill for our services. The initial process is a little bit cumbersome and time-consuming. We will need to forward the initial claim to Medicare through you. Medicare will send you a denial letter, which we need you to give us so we can take over the process and bill the secondary insurance.

We are adding an important update to some of the insurance information we put out in our April Newsletter, regarding the Medicare insurance rider we discussed. We have since found out two things: 1) that the wellness part of the rider is an option a person can choose to add on, but it only allows $250 per year for acupuncture or other alternative treatments; and 2) that in order to be a part of this Medicare rider, a person must drop their other insurance.

Also, we said that we would give discounts to Blue Cross clients. We have since learned that this is illegal. Nancy Brem, L.Ac., is a professional who does things by the book, so we will no longer be able to offer discounts to anyone.

Our Main Insurance Carriers

At present, the insurance companies that North Scottsdale Acupuncture (NSA)has a direct relationship with are listed below, along with the nature of the relationship. As always, your insurer will need to be contacted in order to determine your coverage for acupuncture.

Aetna: NSA is in their network.

Ameriben: This is the health insurance provider for Scottsdale Healthcare Shea hospital employees. NSA is in-network for them, and she has treated a number of SHC employees and been paid for this by Ameriben.

American Specialty Health/ASHlink: NSA used to be in-network with ASH, and we are in the process of reinstating this relationship, which we expect to happen soon.

Blue Cross/Blue Shield: They used to cover acupuncture, but no longer. We have applied to them to become a provider, and this is in process. We do not expect fast action on this.

Cigna: NSA is an out-of-network provider.

Meritus: NSA is a provider in their network.

United HealthCare: This is the company we bill the most by far, and who pays for acupuncture the most by far. But still check with them about your individual policy.

Various other insurers have paid for services for patients at NSA out of network. It all depends on the patient’s policy coverage.

Health Insurance News

In this article, we are providing what information we presently can about the insurances which North Scottsdale Acupuncture is connected with. Especially since Obamacare took effect, many of you have wanted more information about this subject. We will revisit this subject as soon as and whenever there is anything new to add.

More and more, acupuncture and other alternative medical approaches are being covered by insurance. North Scottsdale Acupuncture is a preferred provider for United Health Care and Aetna insurances. We are an Out-Of-Network provider for Cigna until they accept acupuncturists in our zip code. If patients have an Out-Of-Network acupuncture benefit with Cigna, there is a $26 copay. Some Cigna plans offer discounted acupuncture services, and we honor that program as well. Blue Cross/Blue Shield used to cover acupuncture, but they removed it within the last two years. We have decided to offer a 25% discount to BCBS insurance members. We are currently enrolling as a provider for the insurance company Care 1st and other plans under Meritus Health Network. Banner Health Network does not contract with alternative health care providers, but we called them about a potential client. Banner said the person was covered at 100 percent for 20 visits per year.

Ameriben and Honor Health (Scottsdale Lincoln Health Network Health Plan)

The Ameriben health insurance plan which covers employees of Scottsdale Healthcare Shea (SHC) Hospital covers acupuncture treatments by any legally licensed acupuncture provider, including Nancy Brem, L.Ac. She has treated SHC employees and been successfully reimbursed for claims submitted. There appears to be some confusion among some employees about this issue. Here is the exact language from the web: “When benefits for acupuncture are covered by this Plan, such services may be rendered by a Physician (MD or DO) with proper credentials to perform acupuncture in the state in which they are licensed or by an Acupuncturist who is properly licensed by the state in which he or she is practicing and is performing services within the scope of that license, or, where licensing of an acupuncturist is not required, is certified by the National Certification Commission for Acupuncturists (NCCA).
• Services are covered only if the Plan Administrator or its designee determines that the practitioner is licensed or duly authorized to practice in the jurisdiction in which the services are provided.
• Supplements are excluded.”

Medicare

Medicare does not cover acupuncture. There is, however, a rider that employers can purchase for alternative medicine coverage. This can be offered to you through your former (or current) employer, if there is a group of retirees from that employer, and the group is all covered by Medicare A and B. Your employer will not have to pay any of the premium cost.

Merchants Business Admin Seniors Choice Group Retiree Medical Insurance is underwritten by Guarantee Trust Life Insurance. By clicking here, you can see the rider which outlines the plan’s “comprehensive adult wellness benefit”. This set of benefits covers a number of alternative medical approaches, including acupuncture, but only up to $250 per year. This medical insurance plan is not actually a Medicare supplement plan, but is an Employee Group Retiree Medical Plan which coordinates with Medicare. We researched this plan and discovered that the coverage extends to any acupuncturist who has a Licensed clinic, such as North Scottsdale Acupuncture.

So overall, North Scottsdale Acupuncture presently accepts the following insurance plans: Aetna, Cigna (Out-Of-Network), United HealthCare, and Ameriben. We offer discounts to BCBS members, and we are applying to other plans. And the Medicare-related plan described above will cover acupuncture provided by us, if you become a member.

With whatever insurance you have or do not have, you can book an appointment with Nancy by pressing here.